围产期肺栓塞八例临床分析

Analysis of eight cases with perinatal pulmonary embolism

目的分析围产期肺栓塞发病率、高危因素、临床特点及妊娠结局。 方法收集首都医科大学附属北京友谊医院2006年1月至2016年3月间收治的8例围产期肺栓塞患者的临床资料，对其一般情况、临床症状、辅助检查、治疗措施及妊娠结局等进行回顾性分析。 结果我院围产期肺栓塞发病率约为0.029%（8/27 560）。8例中，2例发病在早孕期，溶栓治疗均成功，但1例胎停育，另1例早产分娩；1例晚孕期发病，抗凝治疗成功；5例产褥期发病，其中3例溶栓治疗成功，1例抗凝治疗，1例猝死。8例患者发病前均有明确制动史，5例产褥期肺栓塞患者均发生在剖宫产术后；4例肥胖。8例中，5例有3个及以上的肺栓塞的高危因素，3例有2个高危因素。结论肺栓塞作为高致死性疾病，临床应对有2个及以上高危因素的孕妇提高警惕并加以预防，提高对围产期肺栓塞疾病的认识。

Objective To analyze the incidence, risk factors, clinical characteristics and pregnant outcomes of perinatal pulmonary embolism（PPE）. Methods Clinical data of eight patients who were admitted to Beijing Friendship Hospital of Capital Medical University for PPE from January 2006 to March 2016 were collected. General condition, symptoms, laboratory examinations, images, treatments and outcomes of these patients were analyzed retrospectively. Results The ten-year incidence of PPE was 0.029% （8/27 560） in this hospital. Among the eight cases, two cases were diagnosed in the first trimester, and treated successfully by thrombolytic therapy. But one of two cases stopped growth, while the other one was premature labor. There were one case in the third trimester who had successful anticoagulant therapy and five cases in the postpartum period after cesarean delivery. Among the five cases, three cases were recovered after anticoagulant therapy, one case was recovered after thrombolytic therapy and one case died. All of the eight patients were immobilized before the onset of PPE, and five of them were diagnosed after cesarean section. Four out of the eight patients were obese. Five patients had three or more high-risk factors for pulmonary embolism and the other three had two. Conclusions It is necessary to pay close attention to gravidas who have two or more high-risk factors of PPE due to its fatal outcome.